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General NPI Number Information
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NPI Number | 1003809567
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Entity Type | Individual
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Provider Name | COURTNEY TODD TRIPP DO
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Gender | Male
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Dates
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Enumeration Date | 08/30/2005
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Last Update Date | 04/06/2018
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Provider Practice Location Address
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Address Line | 3050 RICHFIELD DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80919-4535
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Country | US
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Telephone | 719-445-2282
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Fax |
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Provider Business Mailing Address
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Address Line | 3050 RICHFIELD DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80919-4535
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Country | US
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Telephone | 719-445-2282
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | OS010785L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 51776
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | DR.0049439
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 20A10752
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License Number State | CA
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